Methods for treating ophthalmic, otic, or nasal infections

ABSTRACT

The present invention relates to methods for treating an ophthalmic, otic, or nasal infection comprising treating the infected tissue with a composition comprising finafloxacin or a finafloxacin derivative. The present invention also relates to antimicrobial compositions comprising finafloxacin or a finafloxacin derivative. The compositions are suitable for the treatment of ophthalmic, otic, or nasal infections.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims priority under 35 U.S.C. §119 to U.S.Provisional Patent Application No. 61/222,625, filed Jul. 2, 2009, theentire contents of which are incorporated herein by reference.

TECHNICAL FIELD OF THE INVENTION

The present invention generally relates to methods for treating anophthalmic, otic, or nasal disorder. The present invention specificallyrelates to treating an ophthalmic, otic, or nasal infection with acomposition comprising finafloxacin or a finafloxacin derivative.

BACKGROUND OF THE INVENTION

Microbial resistance to conventional antimicrobial treatment is anongoing concern to medical professionals. Until the problem ofresistance is overcome, a steady supply of new treatments and therapiesfor treating microbial infections is required in order to blunt theeffect of microbe mutations that render conventional therapies lesseffective or, in certain cases, ineffective. In particular, resistanceto quinolone antibiotics is becoming a concern.

Quinolone antibiotics are known to have desirable antimicrobialproperties. For example, quinolone compounds for use in the treatment ofophthalmic, otic, and nasal conditions are disclosed in U.S. Pat. No.6,716,830, the entire contents of which are incorporated by referenceherein.

Finafloxacin has been described as useful in the treatment of H. pyloriinfections. Buissonniere et al., “Antimicrobial activity of a newfluoroquinolone, finafloxacin, against H. Pylori in comparison tolevofloxacin” Helicobacter, Vol. 13(5):465, October 2008; U.S. Pat. No.6,133,260 to Matzke et al. Ophthalmic, otic, and nasal applications offinafloxacin are not described.

To cite one of many applications, the use of compositions havingantimicrobial properties is important for the treatment of ophthalmicinfections such as conjunctivitis. Conjunctivitis can be caused byvarious kinds of microbes, with most cases being due to bacteria and/orviruses. Unfortunately, conjunctivitis symptoms are not specific to theetiology of the infectious agent and significant testing may be requiredto determine the causative agent or microbe. Care must be taken inselecting appropriate agents for treating conjunctivitis, given thesensitive tissues affected by the infection. In view of theabove-recited difficulties in treatment, compositions for treatingconjunctivitis are needed that have broad-spectrum antimicrobialproperties, a benign toxicological profile, and/or characteristics thatprevent the transmission of contagious infectious agents.

Otic infections such as acute otitis externa (AOE) and acute otitismedia with tympanostomy tubes (AOMT) are preferably treated by topicalantimicrobial compositions, as the use of oral antimicrobials carriesthe risk of systemic side effects, and can occasionally fail toeradicate such infections with the possible development ofdrug-resistant strains. Recent years have seen a steady increase inquinolone-resistant strains of Staphylococcus and Pseudomonas bacteria,the most common causes of otic infections. In some areas, more than halfof Pseudomonas strains isolated from otic infections are quinoloneresistant. See Ballenger's Otorhinolaryngology: Head and Neck Surgery,Snow. J. et al., page 194, (2009). In addition, the external ear isgenerally an acidic environment due to the presence of cerumen. There isaccordingly a need for additional topical compositions for the treatmentof otic infection that are efficacious at low pH.

BRIEF SUMMARY OF THE INVENTION

The present invention relates to compositions for the treatment ofophthalmic, otic, and nasal disorders comprising finafloxacin or apharmaceutically acceptable salt, derivative, enantiomer, or hydratethereof. In preferred embodiments, such compositions are for thetreatment of ophthalmic, otic, and nasal infections, particularlyinfections caused by various bacterial species. Preferred finafloxacincompositions have an acidic pH which provides for increasedantimicrobial efficacy. Additionally, the present invention relates tomethods for treating an infected to ophthalmic, otic, or nasal tissuecomprising treating the infected tissue with a composition comprisingfinafloxacin.

The compositions and methods of the present invention are useful in thetreatment of acute otic infections, particularly those of the externalear canal such as acute otitis externa (AOE) and acute otitis media withtympanostomy tubes (AOMT). Due to the presence of cerumen, the externalear environment is generally of acidic pH. The present inventors haveunexpectedly found that, when tested at acidic pH, compositionscomprising finafloxacin are generally more efficacious than otherquinolone compositions against microbes commonly found in oticinfections. Finafloxacin compositions of the present invention also havelow potential for inner ear toxicity when used for the topical treatmentof external ear infections. The compositions and methods of the presentinvention are accordingly well suited for the topical treatment of oticinfections.

Certain finafloxacin compositions provide enhanced antimicrobialactivity and may be used to treat infections resulting fromquinolone-resistant microbes. Such enhanced activity is believed toresult from a combination of the increased potency and betterpenetration characteristics of finafloxacin relative to otherantibiotics. Ophthalmic finafloxacin compositions are particularly wellsuited for the topical treatment of ophthalmic infection. Suchcompositions can be formulated at a neutral pH and retain their efficacyagainst common ophthalmic pathogens such as Staphylococcus aureus.

The foregoing brief summary broadly describes the features and technicaladvantages of certain embodiments of the present invention. Additionalfeatures and technical advantages will be described in the detaileddescription of the invention that follows. Novel features which arebelieved to be characteristic of the invention will be better understoodfrom the detailed description of the invention when considered inconnection with any accompanying figures. However, figures providedherein are intended to help illustrate the invention or assist withdeveloping an understanding of the invention, and are not intended to bedefinitions of the invention's scope.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention and theadvantages thereof may be acquired by referring to the followingdescription, taken in conjunction with the figures of the accompanyingdrawing in which like reference numbers indicate like features andwherein:

FIGS. 1 a-1 d are bar charts presenting the results of a guinea pigmodel of otic infection;

FIG. 2 is a graph showing comparative corneal perfusion data for severalquinolone antimicrobials;

FIG. 3 presents the results of an ocular pharmacokinetic study offinafloxacin and ciprofloxacin in corneal tissue following topicaladministration;

FIG. 4 presents the results of ocular pharmacokinetic study offinafloxacin and ciprofloxacin in aqueous humor following topicaladministration; and

FIG. 5 is a chart presenting the results of finafloxacin andciprofloxacin compositions in a rabbit keratitis model study usingStaphylococcus aureus.

DETAILED DESCRIPTION OF THE INVENTION

The compositions of the present invention comprise finafloxacin or apharmaceutically acceptable salt, derivative, enantiomer, or hydratethereof. Finafloxacin(8-cyano-1-cyclopropyl-6-fluoro-7-[(4aS,7aS)-hexahydropyrrolo[3,4-b]-1,4-oxazin-6(2H)-yl]-1,4-dihydro-4-oxo-3-quinolinecarboxylicacid) has the following structure:

A preferred salt for use in embodiments of the present invention isfinafloxacin monohydrochloride. Diasteromerically and enantiomericallypure finafloxacin is also preferred for use in embodiments of thepresent invention. As used herein, the term “finafloxacin” is intendedto encompass finafloxacin and its pharmaceutically acceptable salts,derivatives, enantiomers, or hydrates. The phrase “pharmaceuticallyacceptable” is art-recognized and refers to compositions, polymers andother materials and/or dosage forms which are suitable for use incontact with the tissues of human beings and animals without excessivetoxicity, irritation, allergic response, or other problem orcomplication, commensurate with a reasonable benefit/risk ratio asdetermined by one of ordinary skill in the art.

Finafloxacin and derivatives thereof can be synthesized according to themethods described in U.S. Pat. No. 6,133,260 to Matzke et al., thecontents of which are herein incorporated by reference in theirentirety.

The compositions of the invention are particularly directed towardtreating mammalian and human subjects having or at risk of having amicrobial tissue infection. Microbial tissue infections that may betreated or prevented in accord with the method of the present inventionare referred to in J. P. Sanford et al., “The Sanford Guide toAntimicrobial Therapy 2007” 37^(th) Edition (Antimicrobial Therapy,Inc.). Particular microbial tissue infections that may be treatable byembodiments of the present invention include those infections caused bybacteria, protozoa, fungi, yeast, spores, and parasites. The presentinvention is also particularly directed to antimicrobial compositionsfor and methods of treating ophthalmic, otic, and nasal/sinusinfections.

Certain embodiments of the present invention are particularly useful fortreating ophthalmic tissue infections. Examples of ophthalmic conditionsthat may be treated using compositions and methods of the presentinvention include conjunctivitis, keratitis, blepharitis,dacyrocystitis, hordeolum and corneal ulcers. The methods andcompositions of the invention may also be used prophylactically invarious ophthalmic surgical procedures that create a risk of infection.

Otic and nasal/sinus tissue infections may also be treated byembodiments of the present invention. Examples of otic conditions thatmay be treated with compositions and methods of the present inventioninclude acute otitis externa and otitis media (where the tympanicmembrane has ruptured or tympanostomy tubes have been implanted).Examples of nasal/sinus conditions that may be treated with compositionsand methods of the present invention include rhinitis, sinusitis, nasalcarriage and situations where the nasal or sinus tissues are affected bysurgery.

Embodiments of the present invention may also be used prophylacticallyto prevent infection of a tissue by an infectious agent. In suchembodiments, a tissue at risk of infection is contacted with acomposition of the present invention.

In particular embodiments, a composition of the present invention isadministered once a day. However, the compositions of the presentinvention may also be formulated for administration at any frequency ofadministration, including once a week, once every 5 days, once every 3days, once every 2 days, twice a day, three times a day, four times aday, five times a day, six times a day, eight times a day, every hour,or any greater frequency. Such dosing frequency is also maintained for avarying duration of time depending on the therapeutic regimen. Theduration of a particular therapeutic regimen may vary from one-timedosing to a regimen that extends for months or years. One of ordinaryskill in the art would be familiar with determining a therapeuticregimen for a specific indication that incorporates a pharmaceuticallyeffective amount of finafloxacin or a composition thereof. The phrase“pharmaceutically effective amount” is an art-recognized term, andrefers to an amount of an agent that, when incorporated into apharmaceutical composition of the present invention, produces somedesired effect at a reasonable benefit/risk ratio applicable to anymedical treatment. The effective amount may vary depending on suchfactors as the disease or infectious agent being treated, the particularcomposition being administered, or the severity of the disease orinfection agent.

In addition to finafloxacin, the compositions of the present inventionoptionally comprise one or more excipients. Excipients commonly used inpharmaceutical compositions include, but are not limited to, tonicityagents, preservatives, chelating agents, buffering agents, surfactantsand antioxidants. Other excipients comprise solubilizing agents,stabilizing agents, comfort-enhancing agents, polymers, emollients,pH-adjusting agents and/or lubricants. Any of a variety of excipientsmay be used in compositions of the present invention including water,mixtures of water and water-miscible solvents, such as C1-C7-alkanols,vegetable oils or mineral oils comprising from 0.5 to 5% non-toxicwater-soluble polymers, natural products, such as alginates, pectins,tragacanth, karaya gum, xanthan gum, carrageenin, agar and acacia,starch derivatives, such as starch acetate and hydroxypropyl starch, andalso other synthetic products such as polyvinyl alcohol,polyvinylpyrrolidone, polyvinyl methyl ether, polyethylene oxide,preferably cross-linked polyacrylic acid and mixtures of these products.In preferred embodiments, the concentration of the excipient(s) are,typically, from 1 to 100 times the concentration of finafloxacin and theexcipient(s) are selected on the basis of their inertness towardsfinafloxacin.

Suitable tonicity-adjusting agents include, but are not limited to,mannitol, sodium chloride, glycerin, sorbitol and the like. Suitablebuffering agents include, but are not limited to, phosphates, borates,acetates and the like. Suitable surfactants include, but are not limitedto, ionic and nonionic surfactants, though nonionic surfactants arepreferred, RLM 100, POE 20 cetylstearyl ethers such as Procol® CS20 andpoloxamers such as Pluronic® F68. Suitable antioxidants include, but arenot limited to, sulfites, ascorbates, butylated hydroxyanisole (BHA) andbutylated hydroxytoluene (BHT).

The compositions set forth herein may comprise one or morepreservatives. Examples of such preservatives include p-hydroxybenzoicacid ester, alkyl-mercury salts of thiosalicylic acid, such asthiomersal, phenylmercuric nitrate, phenylmercuric acetate,phenylmercuric borate, sodium perborate, sodium chlorite, parabens suchas methylparaben or propylparaben, alcohols such as chlorobutanol,benzyl alcohol or phenyl ethanol, guanidine derivatives such aspolyhexamethylene biguanide, sodium perborate, or sorbic acid. Incertain embodiments, the composition may be self-preserved that nopreservation agent is required.

For use in sinus applications, compositions may be used that compriseexcipients suitable for aerosol formation using nebulizers or other suchdevices well known to those of skill in the art.

Some compositions of the present invention are ophthalmically suitablefor application to a subject's eyes. For ophthalmic administration, thecomposition may be a solution, a suspension, a gel, or an ointment. Inpreferred aspects, compositions that include finafloxacin will beformulated for topical application to the eye in aqueous solution in theform of drops. The term “aqueous” typically denotes an aqueouscomposition wherein the excipient is >50%, more preferably >75% and inparticular >90% by weight water. These drops may be delivered from asingle dose ampoule which may preferably be sterile and thus renderbacteriostatic components of the composition unnecessary. Alternatively,the drops may be delivered from a multi-dose bottle which may preferablycomprise a device which extracts any preservative from the compositionas it is delivered, such devices being known in the art.

In other aspects, components of the invention may be delivered to theeye as a concentrated gel or a similar vehicle, or as dissolvableinserts that are placed beneath the eyelids. In yet other aspects,components of the invention may be delivered to the eye as ointment,water-in-oil and oil-in-water emulsions.

For topical compositions to the eye, the compositions are preferablyisotonic, or slightly hypotonic in order to combat any hypertonicity oftears caused by evaporation and/or disease. This may require a tonicityagent to bring the osmolality of the composition to a level at or near210-320 milliosmoles per kilogram (mOsm/kg). The pH of the solution maybe in an ophthalmic acceptable range of 3.0 to 8.0. The compositions ofthe present invention generally have an osmolality in the range of220-320 mOsm/kg, and preferably have an osmolality in the range of235-300 mOsm/kg. The ophthalmic compositions will generally beformulated as sterile aqueous solutions.

In certain embodiments, finafloxacin is formulated in a composition thatcomprises one or more tear substitutes. A variety of tear substitutesare known in the art and include, but are not limited to: monomericpolyols, such as, glycerol, propylene glycol, and ethylene glycol;polymeric polyols such as polyethylene glycol; cellulose esters suchhydroxypropylmethyl cellulose, carboxy methylcellulose sodium andhydroxy propylcellulose; dextrans such as dextran 70; vinyl polymers,such as polyvinyl alcohol; and carbomers, such as carbomer 934P,carbomer 941, carbomer 940 and carbomer 974P. Certain compositions ofthe present invention may be used with contact lenses or otherophthalmic products.

In some embodiments, the compositions set forth herein have a viscosityof 0.5-100 cps, preferably 0.5-50 cps, and most preferably 1-20 cps.This relatively low viscosity insures that the product is comfortable,does not cause blurring, and is easily processed during manufacturing,transfer and filling operations.

To effectively treat various microbial infections and to minimizeside-effects, the antimicrobial activity of a composition should bemaximized so that a minimum amount of active ingredient is used. Theactivity of the antimicrobial compositions of the present invention isgenerally the result of the antimicrobial agent itself; the compositioncomponents other than finafloxacin normally cause little effect.

It is also contemplated that the concentrations of the ingredientscomprising the compositions of the present invention can vary. Inpreferred embodiments, finafloxacin is present in ophthalmiccompositions at a concentration of about 0.1% to 1.0% w/v. Particularlypreferred embodiments have a finafloxacin concentration of 0.1% to 0.5%w/v, and most preferred are embodiments having a finafloxacinconcentration of about 0.3% to 0.4% w/v. A person of ordinary skill inthe art would understand that the concentrations can vary depending onthe addition, substitution, and/or subtraction of ingredients in a givencomposition.

Preferred compositions are prepared using a buffering system thatmaintains the composition at a pH of about 3 to a pH of about 8.0 andpreferably from 5.0 to 7.5. Particularly preferred otic compositionshave a pH of 5.0 to 6.0 and most preferred otic compositions have a pHof about 5.9. Particularly preferred ophthalmic compositions have a pHof 6.0 to 8.0 and most preferred ophthalmic compositions have a pH of7.5 to 8.0. In certain embodiments, topical compositions (particularlytopical ophthalmic compositions, as noted above) are preferred whichhave a physiological pH matching the tissue to which the compositionwill be applied or dispensed.

In the methods set forth herein, administration to a subject of apharmaceutically effective amount of a composition that includesfinafloxacin may be by any method known to those of ordinary skill inthe art.

For example, the composition may be administered locally, topically,intradermally, intralesionally, intranasally, subcutaneously, orally, byinhalation, by injection, by localized perfusion bathing target cellsdirectly, via a catheter, or via lavage.

In particular embodiments, the composition is administered topically toan ocular surface. Regarding ophthalmic administration, it iscontemplated that all local routes to the eye may be used, includingtopical, subconjunctival, periocular, retrobulbar, subtenon,intraocular, subretinal, posterior juxtascleral, and suprachoroidaladministration.

The compositions of the present invention may also comprise ananti-inflammatory agent. The compositions of the present invention mayalso contain one or more anti-inflammatory agents. The anti-inflammatoryagents utilized in the present invention are broadly classified assteroidal or non-steroidal. The preferred steroidal anti-inflammatoryagents are glucocorticoids. Glucocorticoids for ophthalmic, otic, ornasal use include dexamethasone, loteprednol, rimexolone, prednisolone,fluorometholone, hydrocortisone, mometasone, fluticasone,beclomethasone, flunisolide, triamcinolone and budesonide.

Non-steroidal anti-inflammatory agents are: prostaglandin H synthetaseinhibitors (Cox I or Cox II), also referred to as cyclooxygenase type Iand type II inhibitors, such as diclofenac, flurbiprofen, ketorolac,suprofen, nepafenac, amfenac, indomethacin, naproxen, ibuprofen,bromfenac, ketoprofen, meclofenamate, piroxicam, sulindac, mefanamicacid, diflusinal, oxaprozin, tolmetin, fenoprofen, benoxaprofen,nabumetome, etodolac, phenylbutazone, aspirin, oxyphenbutazone,NCX-4016, HCT-1026, NCX-284, NCX-456, tenoxicam and carprofen;cyclooxygenase type II selective inhibitors, such as NS-398, vioxx,celecoxib, P54, etodolac, L-804600 and S-33516; PAF antagonists, such asSR-27417, A-137491, ABT-299, apafant, bepafant, minopafant, E-6123,BN-50727, nupafant and modipafant; PDE IV inhibitors, such as ariflo,torbafylline, rolipram, filaminast, piclamilast, cipamfylline, CG-1088,V-11294A, CT-2820, PD-168787, CP-293121, DWP-205297, CP-220629, SH-636,BAY-19-8004, and roflumilast; inhibitors of cytokine production, such asinhibitors of the NF.kappa.B transcription factor; or otheranti-inflammatory agents known to those skilled in the art.

The concentrations of the anti-inflammatory agents contained in thecompositions of the present invention will vary based on the agent oragents selected and the type of inflammation being treated. Theconcentrations will be sufficient to reduce inflammation in the targetedophthalmic, otic or nasal tissues following topical application of thecompositions to those tissues. Such an amount is referred to herein as“an anti-inflammatory effective amount”. The compositions of the presentinvention will typically contain one or more anti-inflammatory agents inan amount of from about 0.01 to about 1.0 wt. %.

Various otic administration techniques are also contemplated. Inparticular embodiments, the composition may be delivered directly to theear canal (for example: topical otic drops or ointments; slow releasedevices in the ear or implanted adjacent to the ear). Localadministration routes include otic intramuscular, intratympanic cavityand intracochlear injection routes for the compositions. It is furthercontemplated that certain compositions of the invention may beformulated in intraotic inserts or implant devices. For instance,delivery of the compositions can be accomplished by endoscopic assisted(including laser-assisted endoscopy to make the incision into thetympanic membrane) injection into the tympanic cavity as set forth, forexample, in Tsue et al., Amer. J. Otolaryngology, Vol. 16(3):158-164,1995; Silverstein et al., Ear Nose Throat, Vol. 76:674-678, 1997;Silverstein et al., Otolaryngol Head Neck Surg, Vol. 120:649-655, 1999.Local administration can also be achieved by injection through thetympanic membrane using a fine (EMG recording) needle, through use of anindwelling catheter placed through a myringotomy incision, and injectionor infusion through the Eustachian tube by means of a small tubalcatheter. Furthermore, the compositions can be administered to the innerear by placement of gelfoam or similar absorbent and adherent productsoaked with the compositions against the window membrane of themiddle/inner ear or adjacent structure with due discretion and cautionby a skilled clinician. Various other devices can be used to deliver thecompositions to the affected ear compartment; for example, via catheteror as exemplified in U.S. Pat. No. 5,476,446 which provides amulti-functional apparatus specifically designed for use in treatingand/or diagnosing the inner ear of the human subject. Also see U.S. Pat.No. 6,653,279 for other devices for this purpose.

Administration of the compositions described herein for the treatment ofnasal infection can be via a number of methods known to those of skillin the art. For example, such compositions can be administered indroplet form or by aerosol formation.

EXAMPLES

Examples 1-7 below were prepared according to embodiments of the presentinvention.

Example 1

Ingredient % w/v Finafloxacin 0.1 to 1.0 Sodium Acetate 0.03 Acetic Acid0.04 Mannitol 4.60 EDTA 0.05 Purified Water q.s. 100%

Example 2

Ingredient % w/v Finafloxacin 0.10 to 1.0  Citric acid 0.2 Sodiumcitrate 0.1 Sodium chloride  0.7* Sodium hydroxide/HCL Adjust pHPurified Water q.s. 100%

Example 3

Ingredient % w/v Finafloxacin 0.10 to 1.0  Boric acid 1.0 Mannitol  3.0*Tromethamine/HCL Adjust pH Purified Water q.s. 100%

Example 4

Ingredient % w/v Finafloxacin 0.10 to 1.0  Boric acid 1.0 Mannitol  3.0*Hydroxyethyl cellulose 0.5 Tromethamine/HCL Adjust pH Purified Waterq.s. 100%

Example 5

Ingredient % w/v Finafloxacin 0.10 to 1.0  Boric acid 1.0 Mannitol  3.0*Carbopol 0.3 Tromethamine/HCL Adjust pH Purified Water q.s. 100%

Example 6

Ingredient % w/v Finafloxacin 0.33 Magnesium Chloride (hexahydrate) 0.3 Sodium Acetate (trihydrate) 0.68 Mannitol 2.5  Benzalkonium Chloride0.01 Sodium Hydroxide/Hydrochloric Acid Adjust pH Purified Water q.s.100%

Example 7

Ingredient % w/v Finafloxacin 0.10 to 1.0  Zinc chloride 0.3-1.0 Sodiumphosphate (anhydrous) 0.3-0.7 Sodium chloride 0.7* Sodium hydroxide/HCLAdjust pH Purified Water q.s. 100% *osmolality adjusted from 200 to 350mOSM/kg

Example 8 In Vitro Antimicrobial Efficacy Studies

A finafloxacin composition at pH 5.8 was compared to ciprofloxacin (pH5.8) and ofloxacin (pH 5.8 and pH 7) compositions using standard invitro antimicrobial susceptibility tests (M07-08 Methods for DilutionAntimicrobial Susceptibility Tests for Bacteria that Grow Aerobically;Approved Standard-Eighth Edition (January 2009, Clinical and LaboratoryStandards Institute), herein incorporated by reference). Minimuminhibitory concentrations (MIC₅₀) were determined using Gram-positiveand Gram-negative test organisms commonly found in otic and ophthalmicinfections. The MIC₅₀ was the lowest concentration of antibiotic thatprevented growth of the test organism, as determined visually by a lackof turbidity.

The results of the experiment are presented below in TABLE 1(Gram-positive organisms) and TABLE 2 (Gram-negative organisms). Thefinafloxacin compositions showed lower MIC₅₀ concentrations for alltested Gram-positive organisms compared to the ciprofloxacin andofloxacin compositions.

TABLE 1 Gram Positive Bacteria Finafloxacin Ciprofloxacin OfloxacinOfloxacin at pH 5.8 at pH 5.8 at pH 5.8 at pH 7 Organism MIC₅₀ (μg/mL)MIC₅₀ (μg/mL) MIC₅₀ (μg/mL) MIC₅₀ (μg/mL) Staphylococcus aureus - 4 12864 32 Ciprofloxacin resistant (N = 12) Staphylococcus aureus - 0.016 1 10.25 Ciprofloxacin sensitive (N = 8) Staphylococcus epidermidis - 2 12832 16 Ciprofloxacin resistant (N = 12_ Staphylococcus epidermidis -0.016 0.5 1 0.25 Ciprofloxacin sensitive (N = 8) Streptococcus pneumonia0.25 1 2 1 (N = 10) Enterococcus faecalis 8 128 16 128 (N = 10)

TABLE 2 Gram Negative Bacteria Finafloxacin at Ciprofloxacin Ofloxacinat Ofloxacin at pH 5.8 pH 5.8 pH 5.8 pH 7 Organism MIC₅₀ (μg/mL) MIC₅₀(μg/mL) MIC₅₀ (μg/mL) MIC₅₀ (μg/mL) Pseudomonas aeruginosa - 16 64 25664 Ciprofloxacin resistant (N = 11) Pseudomonas aeruginosa - 1 1 4 2Ciprofloxacin sensitive (N = 14) Pseudomonas otitidis 0.125 0.25 1 0.25(N = 10) Haemophilia influenzae 0.008 0.016 0.031 0.031 (N = 10)Escherichia coli 4 256 512 16 (N = 10) Proteus mirabilis 0.25 0.125 0.50.125 (N = 10)

Example 9 In Vivo Acute Otitis Externa (AOE) Model

Finafloxacin test compositions (0.3%, 0.03%, and 0.003%) were comparedto ofloxacin (0.3% and 0.03%) and ciprofloxacin compositions (CILOXAN®,Alcon Laboratories, Inc (0.3% ciprofloxacin hydrochloride), 0.03%, and0.003%) in a guinea pig model of acute otitis externa (AOE) usingPseudomonas aeruginosa. Guinea pig ears were slightly abraded and 200 μlof bacterial culture (10⁸ CFU) of P. aeruginosa were instilled into eachear. Ears were lavaged with saline and plated onto Pseudomonas isolationmedia. FIGS. 1 a-1 d summarize the results of these studies.

As shown in FIG. 1 a, a 0.3% composition of finafloxacin resulted inalmost complete eradication of Pseudomonas using two separate doses oftest composition. Lower concentration finafloxacin compositions (0.03%and 0.003%) still achieved very substantial 5-6 log reductions ofPseudomonas in the model. In the tests summarized in FIG. 1 a,finafloxacin performed as well as ciprofloxacin. Finafloxacin was alsocompared to ofloxacin and ciprofloxacin compositions in single dosestudies. FIG. 1 b shows that a 0.3% finafloxacin composition resulted inalmost complete eradication of Pseudomonas in the single dose study.Using a lower concentration composition (0.03%, shown in FIG. 1 c)finafloxacin achieved a 4 log CFU reduction in the single dose study. Inthis study, the finafloxacin composition performed as well as theciprofloxacin composition and better than the ofloxacin composition.FIG. 1 d demonstrates that the use of preservative (BAC) in 0.03% and0.3% finafloxacin compositions does not affect the efficacy offinafloxacin against Pseudomonas compared to self-preservedcompositions.

Example 10 Ocular Pharmacokinetic Studies

FIG. 2 presents comparative corneal perfusion data for several quinoloneantimicrobials (including finafloxacin) using an ex vivo model. 0.1 mMtest solutions at pH 7.3 of four quinolone antimicrobials were comparedin the model. As shown in FIG. 2, the finafloxacin test composition hasbetter corneal perfusion properties than the ciprofloxacin testcomposition and demonstrates less perfusion relative to the ofloxacintest composition.

FIGS. 3 and 4 present the results of ocular pharmacokinetic studiesfollowing topical administration of finafloxacin and ciprofloxacincompositions. The studies utilized New Zealand white rabbits, and 45 μlof 0.3% test composition was instilled bilaterally. As shown in FIGS. 3and 4, respectively, corneal stroma and aqueous humor tissueconcentrations of both finafloxacin and ciprofloxacin were comparable atlater time points, with the ciprofloxacin composition resulting ingreater concentrations immediately following instillation.

Example 11 In vivo Keratitis Study

Two 0.33% finafloxacin ophthalmic compositions with different buffer andpH characteristics were compared to CILOXAN® in a rabbit keratitismodel. New Zealand white rabbits received a corneal injection of 100 CFUof Staphylococcus aureus. The rabbits were treated topically with 45 μlof the test composition once per hour starting 4 hours post-infection (6treatments total). Corneas were harvested and cultured for viable cells1 hour after final test treatment. As shown in FIG. 5, both finafloxacincompositions demonstrated Staphylococcus aureus log reductions in thekeratitis model similar to that of the CILOXAN® composition. In asimilar test using Pseudomonas aeruginosa, finafloxacin compositionsdemonstrated inferior Pseudomonas CFU reductions compared to CILOXAN®.

Example 12 In Vivo Ototoxicity Study

TABLE 3 below presents the results of toxicity testing performed in twoanimals models (chinchilla and rabbit). The tested finafloxacincompositions did not demonstrate inner or outer ear irritation in theanimal models utilized.

TABLE 3 Species Posology Treatment Groups Results Chinchilla 0.5 mLsingle Vehicle pH 5.5 No indications dose with 72 hour (no Mg or Zn) ofinner ear extended Vehicle with 0.13% toxicity in any observations ZnCl₂vehicle for 0.3% Finafloxacin and finafloxacin 0.13% ZnCl₂ groupsVehicle with 0.13% MgCl₂ 0.3% Finafloxacin with 0.13% MgCl₂ Rabbit 0.2mL bid for 7 Saline No indications days followed by Vehicle pH 5.7 (0.3%Mg of significant 7 day and BAC in all) outer ear observations VehiclepH 7.5 irritation with 0.3% Finafloxacin pH 5.7 finafloxacin 0.3%Finafloxacin pH 7.5 0.6% Finafloxacin pH 7.5 1.0% Finafloxacin pH 7.5

The present invention and its embodiments have been described in detail.However, the scope of the present invention is not intended to belimited to the particular embodiments of any process, manufacture,composition of matter, compounds, means, methods, and/or steps describedin the specification. Various modifications, substitutions, andvariations can be made to the disclosed material without departing fromthe spirit and/or essential characteristics of the present invention.Accordingly, one of ordinary skill in the art will readily appreciatefrom the disclosure that later modifications, substitutions, and/orvariations performing substantially the same function or achievingsubstantially the same result as embodiments described herein may beutilized according to such related embodiments of the present invention.Thus, the following claims are intended to encompass within their scopemodifications, substitutions, and variations to processes, manufactures,compositions of matter, compounds, means, methods, and/or stepsdisclosed herein.

What is claimed is:
 1. A method for treating an ophthalmic, otic, ornasal infection comprising: treating the infection with apharmaceutically effective amount of a composition comprisingfinafloxacin at a concentration of 0.1 to 1.0 w/v %.
 2. A methodaccording to claim 1 wherein said infection is a nasal infection.
 3. Amethod according to claim 1 wherein said infection is acute otitisexterna or acute otitis media with tympanostomy tubes.
 4. A methodaccording to claim 1 wherein said composition comprises finafloxacin ora pharmaceutically acceptable salt thereof at a concentration of 0.1 to0.5 w/v %.
 5. A method according to claim 1 wherein said compositioncomprises finafloxacin or a pharmaceutically acceptable salt thereof ata concentration of 0.3 to 0.4 w/v %.
 6. A method according to claim 1,said composition having a pH of 5.0 to 7.5.
 7. A method according toclaim 1, said composition having a pH of 5.0 to 6.0.
 8. A methodaccording to claim 1, said composition further comprising ananti-inflammatory agent.
 9. A method according to claim 8 wherein saidanti-inflammatory agent is dexamethasone.
 10. A method according toclaim 1 wherein said infection is an otic infection.